MEDICARE: CHARLES HERBERT STEWART M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	167503-1205	UT

General Provider Information

NPI Number	:	1942210406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES HERBERT STEWART M.D.

Provider Business Mailing Address
First Line	:	3650 N UNIVERSITY AVE
Second Line	:	SUITE 200
City	:	PROVO
State	:	UT
Zip	:	84604-6656
Country	:	US
Telephone Number	:	801-375-4100
Fax Number	:	801-427-3251

Provider Business Practice Location Address
First Line	:	3650 N UNIVERSITY AVE
Second Line	:	SUITE 200
City	:	PROVO
State	:	UT
Zip	:	84604-6656
Country	:	US
Telephone Number	:	801-375-4100
Fax Number	:	801-427-3251

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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